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Editor's Correspondence |

Nonfasting Lipids: There Is the Population and Then There Is the Patient

Seth S. Martin, MD; Michael J. Blaha, MD, MPH; Steven R. Jones, MD
JAMA Intern Med. 2013;173(10):936-937. doi:10.1001/jamainternmed.2013.383.
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We congratulate Sidhu and Naugler1 on their article lending support to nonfasting lipid profiling. To inform the care of an individual patient, Sidhu and Naugler1 focus on the average population-level impact of nonfasting on lipid levels. However, to help bring their results closer to the bedside, patient-level considerations must be highlighted.

In primary care offices, low-density lipoprotein cholesterol (LDL-C) is the central focus on lipids, as recommended by worldwide dyslipidemia treatment guidelines.2,3 For 4 decades, the medical community has estimated LDL-C level by the Friedewald equation.4,5 The equation performs very well at a population level. However, as Dr Friedewald described,4 simply dividing triglyceride level by 5 does not give a very accurate estimate of very large-density lipoprotein cholesterol (VLDL-C)—the importance of inaccuracy depends on what fraction of the equation VLDL-C constitutes in the individual patient.

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